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pharmacology > pharmacothrapy of ischemic heart disease > Flashcards

pharmacothrapy of ischemic heart disease Flashcards

1
Q

what are the three types of ischemic heart diseases ?

A

stable
unstable
prinzemetal angina = angiopastic

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2
Q

what are the lifestyle modifications for ischemic heart disease ?

A

smoking

diet = bmi needs to be between 18 - 25, waist 102cm for men and 88 for women

moderate to vigorous exercise training for 3 or more times a weak for 30min

sexual activity : nitroglycerin prior to it , as there can be ischemia
erectile dysfunction more prevalent in patients with coronary artery disease.

lipid managemnt with statins

hypertenison = less than 140/90

diabetes = hb1ac less than 7 percent

psychosocial factors

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3
Q

what are the aims for stable coronary artery dsease ?

A

relief of anginal symtoms using anti ischemic or antianginal drugs

and prevention of MI

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4
Q

what are the main groups in the treat for nti ischemic (antianginal) drugs for symptom relief ?

A

organic nitrates (1st line except for long acting)

beta blockers (1st line)

calcium channel blockers (1st line)

2nd line
inhibitors of If current

metabolic modulators

inhibitors of slowly inactivating sodium current

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5
Q

what are the organic nitrates ?

A

glyceryl trinitrate ( fast onset and short duration) SUBLINGUALLY :
nitroglycerin
nitrolingual
perlinganit

long duration of action nitrates :
isosorbide mono/dinitrate
pentaerithitryl tetranitrate

sydnomines :
molsidomine

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6
Q

what are the side effects of organic nitrates ?

A 
headache 
flushing 
hypotension - syncope  /postural hypotension 
reflex tachycardia 
methemoglobulinemia
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7
Q

what are the contraindications using organic nitrates ?

A

hypertrophic obstructive cardiomyopathy

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8
Q

what are the drugs not recommeneded with organic nitrates

A

phosphodiesterase inhibitors = sidenafil

alpha adrenergic blockers (for men with prostatic problems take tamsulosin and a1A and A1D alpha blocker)

calcium channel blockers

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9
Q

what are the beta blockers ?

A

non selective
propranolol

b1 selective
meto
biso
ateno

vasodilative
carvedilol
nebivolol

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10
Q

what are the side effects of beta blockers ?

A 
peripheral vasoconstrition 
bradycardia 
postural hypotension 
heart block 
bronchospasm 
hypoglycemia and mask hypoglycemic signs

decrease HDL and increases TG
INCREASE INSULIN RESISTANCE
sexual disorders

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11
Q

contraindication of beta blockers ?

A 
bradycardic 
cardiogenic shock 
asthma or COPD (use beta selective) 
in diabtetes needs to be examined 
peripheral vascular disease 
PRINZEMETAL ANGINA
decompnesated heart failure
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12
Q

drugs which are not given with beta blockers are ?

A

non dhp

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13
Q

what are the calcium channel blockers ?

A

dihydropridines
nifedipine
felodipine
DIPINES

non dihydropyridines (heart rate lowering calcium channel blockers)
verapamil
diltiazem

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14
Q

what are the side effects of DHP?

A

ankle swelling
flushing
reflex tachycardia

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15
Q

what are the contraindications in the use of DHP ?

A

cardiogenic shock
arotic stenosisi
obstructive cardiomyopathy

tachyarrythmia’s
congestive heart failure

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16
Q

we do not use DHP with which drugs ?

A

CYP3A4 susbtrates

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17
Q

what are the side effects of non DHP ?

A 
bradycardia 
heart conductive defects 
lower ejection fraction 
constipation 
gingival hyperplasia
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18
Q

contraindictaion of non DHP ?

A

bradycardia
arrythmia
sinus syndrome
hypotension

conduction block
and congestive heart disease

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19
Q

drug to drug interaction of NON DHP that needs to be avoided ?

A

beta blockers

CYP314 substrates

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20
Q

what are the inhibitors of If current ?

A

ivabradine

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21
Q

what are the side effecets of ivabradine ?

A 
visual distrubance 
atrial fib
heart block 
dizziness 
bradycardia
22
Q

contraindication of ivabradine ?

A

arrythmic disroder
and braduycardic
severe HEPATIC DISEASE

if age over 75 an severe ranl failur needs to be with precaution

23
Q

what are the drugs inhibited with ivabradine ?

A 
QT prolonging drugs 
macrolides 
anti hiv drugs 
antifungal drugs 
NON DHP
24
Q

what are the metabolic modulators ?

A

trimetazidine

25
Q

what are the inhibitors of slowly inactivating sodium current

A

ranolazine

26
Q

what are the side effects of metabolic modultaors (trimetazidine)

A

gastric discomfort

movement disorders

27
Q

what are the contraindications for trimtazidine?

A

parkinson
termor
movemnet diroserds
severe renal impairment

28
Q

what are the drugs for prevention of myocardial infraction?

A

ANTIPLATELET DRUGS:
inhibitors of TxA2 synthesis-ASA

adenosine (P2Y12) receptor antagonist ADP inhibit platelet aggregation - clopidrogel , prasugrel , ticagrelor

HMG CO-A REDUCTASE INHIBITORS (STATINS)

DRUGS AFFECTING RAAS SYSTEM:
ACEI = enalapril , ARBS - valsartan

29
Q

when there is stable angina what are the steps the patient should take ?

A

should sit down (standing promortes syncope and lying down enhances heart work)

30
Q

which acts more rapidly nitroglycerin spray or tablets ?

A

spray

31
Q

what is the recommendation of the intake of nitroglycerin

A

the patient can take sublingual nitroglycerin every 5 until pain subsides or the maximum of 1.2mg in 15 minutes

32
Q

in order to minimse tolerance to nitroglyerin what should be done ?

A

8 hour nitrate free period and then use the minimum effective dosage

33
Q

what is the mechanism of action of beta blockers ?

A

reduce heart rate
reduce contractility
reduce AV conduction
ectopic activity

prolong diastole

34
Q

which drug can beta blockers go well with

A

DHP

35
Q

what is the mechanism of action in calcium channel blockers ?

A

DHP - vasodilation

non DHP - bradycardia and reduce contractility

36
Q

what are the other indication we can uses non dhp for ?

A

supraventricular tachycardia
hypertension
prinzmetal angina

37
Q

what is the mechanism of ivabradine

A

heart rate lowering by acting on the SAN

38
Q

when do we indicate ivabradine ?

A

chronic stable angina form and there inadequatley controlled heart rate by beta blokers reaching more than 60 bpm

39
Q

which drug can be used in combination with ivabradine ?

A

beta blockers

40
Q

metabolic modulators are used in combination with ?

A

beta blockers

41
Q

mechanism of action of ranolazine ?

A

reduces late sodium current facilitatimg calcium entry
calcium reduction = contractility ionotropic reduction
modify fatty acid oxidation
prolong QT

42
Q

what is the optimal risk to benefit ration in which ASA should begiven so no gastric problems arise ?

A

75-150mg/day

43
Q

what is the mechanism of action of statins ?

A

inhibt cholestrol synthesis in liver
increased expression of ldl expression on hepatocytes
therefor clearing of LDL-c from blood

decrease TG

mildly raise HDL

========
decrease migration and rpoliferation of vascular smooth muscle
decrease oxidative modification of LDL-c
decrease uptake of modified cholestrol by macrophages
decrease endothelila dysfuction
decrease CRP
increase fibrinlytic activity

44
Q

what are the side effects of statins ?

A 
RARE but serious 
increas liver enzymes mildly 
increase creatine phosphokinase 
MYALGIA
myositis and rhabdomyolysis 
alzhiemer disease

frequent but not serious ?
diarrhea
pharyngitis
rashes

45
Q

contraindication of statins ?

A

pregancy tetrogenic

46
Q

what are the drug to drug intercation of statins ?

A 
never given with CYP3A4  inhibitors , 
fibrates and niacin because it can increase the risk of myotoxicity 
macrolides
non DHP 
calcum channel blockers 
amiodarone 
antiviral portease inhibotr - ritanovir
grapfruit juice 
genfibrosil 
immunosuppresant cyclosporin A
47
Q

ACE inhibitors are particularly given when ?

A

systolic ejection fraction is equat to or ore than 40 percent
diabetes
chronic kidney disease
hypertension

48
Q

when we have cardiovascular disease why do we not give nsaids and COX2 inhibtors for pain relief

A

associated with coronary heart disease therfore start of with asprin and paracetamol at the lowest dose

if nsaid needed - lowest dosage and shortest duration

49
Q

chronic preventionof prinzmetal angina is in the use of ?

A

CCB

long acting nitrates can be added and should be used at particular period of day with ischemia most likely occur to prevent nitrate tolerance

if still inefficient = clonidine

50
Q

PRINZEMETAL ANGINA SHOULD NOT USE WHAT DRUG ?

A

beta blockers = cause alpha adreneergic vasoconstriction

pharmacology (7 decks)

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